A research study led by the University of Surrey has found that basic text reminders can play a significant role in increasing bowel cancer screening rates in London. The study, which involved collaboration with University College London and Queen Mary University of London, tested two different methods to encourage individuals who did not respond to their initial screening invitation to complete the test. Over 3,000 people across eight London boroughs participated in the study, which compared the effectiveness of automated text message reminders and personalized telephone support.
The results showed that both methods significantly increased screening uptake among initial non-responders, with a three-fold increase compared to those who received no follow-up. The automated text reminders, sent at 19, 21, 23, and 25 weeks, increased uptake from 2.0% to 6.5%, while telephone support from trained navigators resulted in a 7.5% uptake rate. Notably, the text message method was found to be cost-effective, with a cost of £1.82 per additional person screened.
Currently, London’s bowel cancer screening rate stands at 63.8%, which is eight percentage points lower than the national average. Early detection through screening is key for improving cancer outcomes, but many individuals fail to complete their test kits after receiving them.
When participants received a call from a patient navigator, they were more likely to take action, especially if they believed they were already up to date. The navigators helped individuals overcome specific barriers to screening, and fewer than 1% of participants opted out of receiving text messages. All participants who answered the phone rated their experience highly.
Understanding Screening Barriers and Mechanisms
The study, conducted between June and July 2025, involved 3,129 people who had not returned their screening kits within 18 weeks. The participants were randomly assigned to one of three groups: no further contact, automated text reminders, or an initial text followed by telephone calls from patient navigators. The NHS Bowel Cancer Screening Program offers fecal immunochemical test (FIT) screening to adults aged 50-74 in England.
Common reasons for not screening included believing one was already up to date (19.4%), not receiving the test kit (19.4%), and being too busy (13.4%). The navigators found that men who thought they were up to date were particularly responsive to telephone support, with 39.6% completing screening after the call, compared to 20.4% of women who reported the same reason.
Dr. Robert Kerrison, project lead from the School of Health Sciences at the University of Surrey, stated, “A simple text message at the right time can prompt someone to complete a test that could save their life, and it costs less than a cup of coffee per person. We were particularly struck by how well telephone support worked for men. This is valuable insight when we are designing services.
Neither approach exacerbated existing inequalities in screening uptake. Both methods were effective across all demographic groups, including those in deprived areas. Dr. Kerrison added, “Bowel cancer is the UK’s second-biggest cancer killer, but when caught early it is treatable and curable. An absolute increase of 4.5 to 5.5 percentage points among non-responders in London would translate to 18,000 more people being screened each year. That is significant when we are trying to close an eight-percentage-point gap with the national average. These interventions give us practical, evidence-based tools to do that.
Study Publication and Implications
The study’s findings suggest that text message reminders could be implemented across London to help reduce regional inequalities in screening uptake. The study has been published in the British Journal of Cancer. The results of the study, titled “Which Is More Effective at Improving Uptake of Bowel Cancer Screening: Text Message Reminders or Patient Navigation? Results from a Three-Arm RCT,” are available in the British Journal of Cancer (2026), DOI: 10.1038/s41416-026-03645-1.